Hepatobiliary & Genitourinary

1. Hepatobiliary & Genitourinary Spring 2013 RT 91 PATHOLOGY

2. Hepatobiliary System • Comprised of: • Liver • Gallbladder • Biliary tree • Pancreas shares a portion of the biliary ductal system

3. Biliary System

4. Biliary Tree

5. Hepatobiliary

6. Inflammatory Diseases

7. Cirrhosis • CT is modality of choice • Shrunken liver & ascites • X-ray not useful • US also used • Demonstrates enlargement of spleen and liver • Biopsies done under US

8. Cirrhosis • Chronic liver condition liver parenchyma is destroyed & fibrous tissue is laid down • Regenerative nodules are formed • Results from alcoholism, drug abuse, autoimmune disorders, metabolic & genetic disease, hepatitis, heart problems, biliary obstruction

9. Cholelithiasis • Most commonly demonstrated with US • Most calculi are radiolucent • 20% are calcified enough to see on x-rays

10. Cholelithiasis • Greater incidence in people who are: • diabetic • obese • elderly • have a diet high in fats sugar and salt • low in fiber • Symptoms • Bloating, nausea, RUQ pain

11. Cholecystitis • Acute inflammation of the gallbladder • Sudden onset of pain, fever, nausea & vomiting

12. Cholecystitis • Stones may be visible on • CT • plain films • US • X-rays appear as radiopaque stones • Have thickened walls surrounding gallbladder

13. Pancreatitis • Primary Modalities: • CT and US • Secondary: • Endoscopy & MRI • CT demonstrates an enlargement of the gland • Pancreas has a shaggy irregular contour

14. Pancreatitis • Inflammation of pancreas • Causes include: • alcoholism • obstruction of ampulla of vater by gallstone or tumor • Can be chronic or acute • Chronic causes irreversible change to the pancreatic function

15. Neoplastic Diseases

16. Hemangioma • Increased echogenicity may be demonstrated in US • US can assess shape and size of tumor • NM using labeled blood cells that are attracted to the tumor • CT & MRI with contrast demonstrates peripheral enhancement

17. Hemangioma Most common tumor of the liver Well circumscribed CAN range from microscopic to 20 cm More common in women than men It is a benign neoplasm

18. Metastatic Liver Disease • US is most commonly used to screen • CT & MRI all accurate diagnosis • Liver biopsy under US provides definitive diagnosis

19. Metastatic Liver Disease • Much more common than primary carcinoma of the liver • It is a common site for metastases from primary sites • Colon • Pancreas • Stomach • Lung • breast

20. Pancreatic Cancer CT is the best method of imaging the pancreas Sonography is used to evaluate the biliary tree

21. Pancreatic Cancer • 5th leading cause of cancer death in the U.S. • Prognosis is poor • 2% survival rate • Signs & symptoms are nonspecific • Tumor is well advanced when diagnosis is made

22. Carcinoma of Renal Cells • US reveals as a solid mass • CT is the most accurate for diagnosis & regional spread • 10% have calcifications • MRI allows demonstration of renal anatomy & approaches accuracy of CT • More definitive than CT if contrast enhancement cannot be used

23. MISC pathologies ofHepatobiliary System

24. Biliary Stenosis

25. Genitourinary System

26. Urinary System

27. Benign Prostatic Hyperplasia • Enlargement can be demonstrated on an intravenous urographic exam as a filling defect at the base of the bladder • CT and MRI can also identify pathology

28. Benign Prostatic Hyperplasia • Most common benign enlargement • Can be diagnosed with rectal exam & PSA levels • Generally affects men over 50 • Symptoms • Difficulty starting, stopping, & maintaining urine flow • Can cause urinary obstruction & UTI’s

29. Congenital Anomaly

30. Renal Agenesis • Congenital anomaly • Absence of one kidney & opposite kidney is enlarged

31. Hypoplasia • A underdeveloped kidney that is smaller in size but works normally • Often other kidney is larger to compensate • Significance of this anomaly depends on the volume of functioning

32. Horseshoe Kidney Kidney function is generally unimpaired If obstruction is present surgery may be required Most common fusion anomaly Lower poles of kidney are joined Causes a rotation anomaly on one or both sides

33. Horseshoe Kidney

34. Kidney Malrotation • Incomplete or excessive rotation of the kidneys • No clinical significance unless it causes an obstruction

35. Kidney Malrotation

36. Pelvic or Ectopic Kidney • Kidney or kidneys are lower than normal, often in pelvic region • Most asymptomatic but there is an increased incidence of ureteropelvic junction obstruction

37. Pelvic or Ectopic Kidney

38. Double Collecting System

39. Double Collecting System

40. Ureterocele Cyst like dilatation of a ureter near its opening into the bladder X-ray demonstrates a filling defect of the bladder US demonstrates a cyst

41. Urteterocele

42. Bladder Diverticula • Con occur congenitally or caused by chronic bladder obstruction and infection

43. Polycystic Kidney • US demonstrates renal & hepatic cysts • IVU show bilateral enlargement of the kidneys, calyceal stretching & distortion (poorly visualized outlines) • CT demonstrates a moth eaten appearance • CT & US can detect before conventional x-rays

44. Polycystic Kidney • Congenital disease • Cysts enlarge as pt ages • Enlargement destroys normal tissues • It is the cause of 10% of end-stage renal disease

45. Inflammatory Diseases

46. Pyelonephritis • Can be demonstrated on a CT and US • IVU will often look normal in a acute attack • Interstitial edema causes less visualization of collecting structures

47. Pyelonephritis • Bacterial infection of the calyces and renal pelvis • Stagnation or obstruction of urine flow causes an infection • People with recurrent UTI’s have more of a chance of getting this

48. Cystitis • Inflammation and congestion of the bladder mucosa • Cystography may demonstrate backflow of bladder into ureters

49. Urinary System Calcifications

50. Staghorn Calculus • LG calculus that assumes shape of pelvicaliceal junction • Most visible on x-ray, IVU or retrograde pyelogram • CT’s bone study is the modality of choice